Provider Demographics
NPI:1164657334
Name:PAYNE, ALMA LEE
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:LEE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40015 SIERRA HWY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2101
Mailing Address - Country:US
Mailing Address - Phone:661-317-8365
Mailing Address - Fax:
Practice Address - Street 1:40015 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2101
Practice Address - Country:US
Practice Address - Phone:661-418-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X, 171M00000X
KS2010-27408253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No253Z00000XAgenciesIn Home Supportive Care